Pre-Procedural Glucose Levels and the Risk for Contrast-Induced Acute Kidney Injury in Patients Undergoing Coronary Angiography

Joshua M. Stolker, Peter A. McCullough, Seshu Rao, Silvio E. Inzucchi, John A. Spertus, Thomas M. Maddox, Frederick A. Masoudi, Lan Xiao, Mikhail Kosiborod

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86 Scopus citations

Abstract

Objectives: We sought to evaluate whether pre-procedural glucose levels are associated with contrast-induced acute kidney injury (CI-AKI) after coronary angiography. Background: Although diabetes is a known risk factor for CI-AKI in patients undergoing coronary angiography, whether elevated pre-procedural glucose levels (regardless of pre-existing diabetes) are associated with higher risk for CI-AKI is unknown. Methods: We evaluated 6,358 patients with acute myocardial infarctions undergoing coronary angiography. Patients were stratified into 5 pre-procedural glucose groups: <110 mg/dl, 110 to <140 mg/dl, 140 to <170 mg/dl, 170 to <200 mg/dl, and ≥200 mg/dl. Logistic regression models were used to evaluate the relationship between glucose levels and risk for CI-AKI, first in the entire cohort and then in patients with and without established diabetes. The primary outcome was CI-AKI (≥0.3 mg/dl absolute or ≥50% relative serum creatinine increase during 48 h after the procedure). Results: The relationship between pre-procedural glucose and CI-AKI varied markedly in patients with and without diabetes. There was a strong association between glucose and CI-AKI risk in patients without diabetes (CI-AKI rates across the 5 glucose groups from lowest to highest: 8.2%, 9.9%, 12.4%, 14.9%, and 24.3%; p < 0.001), but not in patients with diabetes (20.9%, 16.1%, 16.3%, 14.8%, and 19.2%, respectively; p = 0.24; p for glucose × diabetes interaction <0.001). After adjusting for confounders (including baseline glomerular filtration rate), the relationship between higher glucose and greater CI-AKI risk persisted in patients without diabetes (odds ratios [95% confidence intervals] for glucose groups of 110 to <140 mg/dl, 140 to <170, mg/dl 170 to <200 mg/dl, and ≥200 mg/dl: 1.31 [1.00 to 1.71], 1.51 [1.11 to 2.10], 1.58 [1.03 to 2.43], and 2.14 [1.46 to 3.14] vs. glucose <110 mg/dl, respectively), but this relationship was not seen in patients with established diabetes. Conclusions: Elevated pre-procedural glucose is associated with greater risk for CI-AKI in patients without known diabetes who undergo coronary angiography in the setting of acute myocardial infarction. Measures used to prevent CI-AKI should be considered in these patients.

Original languageEnglish
Pages (from-to)1433-1440
Number of pages8
JournalJournal of the American College of Cardiology
Volume55
Issue number14
DOIs
StatePublished - Apr 6 2010

Keywords

  • acute kidney injury
  • contrast nephropathy
  • coronary angiography
  • diabetes
  • glucose
  • myocardial infarction

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